Induction is one of the most common health care interventions in the United States, occurring in 23% of all deliveries. Elective induction is generally discouraged in nulliparous women because it was thought to increase cesarean delivery rates and hospital costs without appreciable maternal or neonatal benefit. These assumptions, however, have been challenged in recent years. The Eunice Kennedy Shriver National Institute of Child Health and Human Development?s Maternal-Fetal Medicine Units (MFMU) Network?s ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, a multicenter randomized trial of induction versus expectant management in nulliparous women at 39 weeks of gestation, provides a unique opportunity to measure a critical and understudied outcome: the cost of a common, expensive, and modifiable practice in healthcare. The objective of this proposed project is to assess the economic consequences of elective labor induction compared to expectant management at 39 weeks of gestation in low-risk pregnancies. We propose to measure the direct, itemized, comprehensive healthcare costs of induction and expectant management using advanced analytic tools for the approximately 1,300 patients projected to enroll in ARRIVE at the Utah MFMU study site. The results of the proposed study will supplement and elevate the influence of the ARRIVE trial by providing data that can inform value-based decisions and policies regarding elective induction. In addition, the proposed study, fostered by a multidisciplinary expert research team, will provide critical research skills in healthcare economic analytics for a promising clinician-scientist in the field of obstetrics.